超声造影对肝脏占位性病变的诊断价值

目的探讨超声造影对肝脏占位性病变良、恶性鉴别诊断的价值。方法 2018年5月至2019年10月对30例肝脏占位性病变病人经外周肘静脉注射造影剂Sono Vue行超声造影检查,依据病变的造影开始增强时间、达峰时间及开始消退时间对其进行良恶性鉴别诊断,并分析不同类型肝脏占位性病变的增强模式。结果以手术或穿刺病理确诊病变类型:恶性病变21个(肝细胞性肝癌14个,胆管细胞性肝癌1个,转移性肝癌6个),以穿刺病理或随访MR/CT临床诊断良性病变11个(肝血管瘤9个,肝脏局灶性结节增生1个,肝硬化结节1个)。超声造影正确诊断恶性病变21个,正确诊断良性病变10个。恶性病变开始增强时间(12.76±2.68 s vs. 16.12±3.82s)、达峰时间(23.18±3.57 s vs. 42.78±10.46 s)、开始消退时间(40.69±8.42 s vs. 78.35±14.63 s),大部分恶性病变明显早于良性病变,但有小部分不同类型病变间有交叉。结论超声造影对肝脏占位性病变良、恶性的鉴别诊断准确率较高,具有较高的应用价值。

Evaluation of contrast-enhanced ultrasound in the diagnosis of focal hepatic lesions

［Abstract］ Objective To explore the value of contrast-enhanced ultrasound （CEUS） in the differential diagnosis of benign and malignant liver lesions. Methods From May 2018 to October 2019, 30 patients with focal hepatic lesions were performed contrast-enhanced ultrasound （CEUS） examination in our hospital. After SonoVue （a contrast agent） was injected into the peripheral elbow vein, time-to-peak, wash-in time, wash-out time were recorded and made the differential diagnosis of benign and malignant lesions, and the data were statistically analyzed. Results Pathological results from operation or fine-needle aspiration biopsy, 21cases with malignant lesions （including 14 HCC, 1 cholangiocarcinoma and 6 metastatic HCC）, 11 cases of benign lesions （9 hemangiomas, 1 focal nodular hyperplasia, 1 cirrhosis）. 21 malignant lesions and 10 benign lesions were correctly diagnosed by CEUS. The wash-in time was 12.76 ± 2.68 s vs. 16.12±3.82 s, time-to-peak 23.18±3.57 s vs. 42.78±10.46 s, wash-out time 40.69±8.42 s vs. 78.35±14.63 s between malignant lesions and benign lesions, and in which most of the malignant lesions were earlier than the benign ones. Conclusion CEUS is a very reliable technique with a high sensitivity for the differential diagnosis of benign and Malignant local hepatic lesions.